Objective: Rotator cuff tears can influence shoulder kinematics and severely impair function. However, there have been no studies on three-dimensional (3D) shoulder kinematics in massive rotator cuff tear (MRCT) patients. Hypothesizing that MRCT patients could demonstrate significantly changed scapular kinematics during arm elevation in the scapular plane, we compared 3D scapular kinematics in the scapular plane between MRCT patients and healthy elderly subjects. Methods: We assessed 15 shoulders of 11 MRCT patients and 16 shoulders of 16 healthy subjects. With the subjects seated, we used an electromagnetic tracking system to calculate the upward rotation, posterior tilt, and internal rotation of the scapula at 10° increments from 30° to 120° with respect to the thorax. We performed two-way analysis of covariance with the initial position of the scapular motion as the covariate and performed multiple comparisons using the Bonferroni method. Results: MRCT patients exhibited significantly higher scapular upward rotation than did the healthy subjects (P < 0.05). There were no significant differences between groups with regard to posterior tilt and internal rotation. Conclusions: This study indicated that when MRCT patients elevated their arms, they exhibited a significantly higher scapular upward rotation at low- to mid-range elevations compared with that of healthy subjects. This difference may have resulted from a compensatory effect in response to the decreased elevation torque caused by the loss of rotator cuff function. These results may assist rehabilitation strategies to improve active arm elevation in MRCT patients.
Objective: Rehabilitation for dementia is important in Roken Geriatric Health Service Facilities in Japan. This study evaluated the effects of a cooking program as rehabilitation for elderly residents with dementia. Methods: We carried out a 12-week cooking program based on the five principles of brain-activating rehabilitation (BAR): fostering a pleasant atmosphere, interactive communication, establishing social roles, giving and receiving praise, and errorless learning. The program was carried out in small groups and consisted of 90-min classes once a week. Participants were 36 elderly residents with dementia (mean 85.4 ± 6.5 years) who were randomly divided into intervention (n = 18) and control (n = 18) groups. The control group participated in recreation and both groups received individual conventional rehabilitation twice a week for 30 min. The effects of intervention were evaluated using nine outcome measures. Results: A total of 29 participants were included in the analysis (two-way analysis of variance). The attendance rate was 86.6% in the intervention group (n = 13). The Yamaguchi Kanji Symbol Substitution Test (executive function) showed significant interaction (F(1, 27) = 4.305, P = 0.048) between the two groups: the control group (n = 16) showed significant deterioration (pre 4.9 ± 5.6 to post 3.0 ± 4.9; P = 0.032). The dementia behavior disturbance scale also showed significant interaction (F(1, 29) = 13.298, P = 0.001): the intervention group (n = 16) showed significant improvement (pre 21.6 ± 12.2 to post 11.4 ± 11.5; P < 0.001). No significant differences were observed in the other outcome measures. Conclusions: Our findings suggest that a cooking program based on BAR can reduce the behavioral and psychological symptoms of dementia and maintain executive function.
Objective: Elderly people’s success in attaining rehabilitation goals may be heavily dependent on their achievement motive, but research has not identified the factors that impact on achievement motive or suggested any effective interventions to enhance it. This study demonstrated the effects of personality traits, theories of intelligence, and other factors on achievement motive among community-dwelling elderly people. Methods: The dataset consisted of questionnaire responses from 281 elderly people in day-service or day-care centers. A hypothetical model, based on previous research, proposed that achievement motive would be affected by personality traits, theory of intelligence, and other factors (such as drinking and smoking habits, going out for activities, marital status, and hobbies); that personality traits would have some effect on the theory of intelligence and other factors; and that the theory of intelligence would affect personal factors. The hypothetical model was analyzed using a structural equation modeling approach. Results: The model was modified by removing statistically insignificant paths to achievement motive. The modified model exhibited an excellent fit and showed that achievement motive was affected by personality traits, going out for activities, and marital status (although, surprisingly, single people had stronger achievement motive). The model had an adjusted R2 of 0.593 (P < 0.001) for achievement motive. Conclusion: The results indicated that three of the Big Five personality traits (extraversion, conscientiousness, and openness to experience) tend to enhance elderly people’s motivation to achieve their goals; moreover, going out more frequently and being single were also associated with achievement motive.
Objective: Treatment of large advanced osteochondritis dissecans (OCD) of the elbow in young athletes is challenging. Methods: We retrospectively reviewed the results in 9 baseball players (mean age, 13.7 years; range, 12–15 years) who were followed up for a mean 21.1 months (range, 12–36 months) after osteochondral autograft. In this operation, cylindrical osteochondral plugs were harvested from a lateral femoral condyle and transferred to the lesion in humeral capitellum. After immobilizing the elbow by a splint for 2 weeks, the patients were encouraged to do range of motion exercises using an elbow brace with a hinge for 2 months. The elbow brace was applied to avoid excess stress to the implants on the capitellum and to the lateral collateral ligament. Patients were clinically assessed by the Japanese Orthopaedic Association elbow score (JOA score) and morphologically by radiographs as well as by magnetic resonance imaging (MRI). Results: Patients started playing catch at 3 months and returned to baseball at competitive level at around 6 months postoperatively. The average JOA score was 68.0 points before operation and improved to 98.7 points at follow-up. Bony fusion between the implants and host bone was observed radiographically at 3 months. MRI confirmed a durable load-bearing articular surface of the capitellum at 1 year. Conclusions: Osteochondral autograft with postoperative rehabilitation using an elbow brace is a reasonable treatment for young athletes with an advanced lesion of OCD of the elbow who desire a relatively quick return to their pre-injury sports activity level.
Background: Reconstructive hand surgery is well established for the management of patients with rheumatoid arthritis; however, with the advent of biologic drugs and methotrexate, disease activity, including the development of hand deformities, is well controlled. Nonetheless, many patients still need personalized surgery. Case: A 61-year-old woman with a 35-year history of rheumatoid arthritis presented with right hand deformity with unstable ulnar deviation of the metacarpophalangeal joints from the index to the little finger and hyperextension of the thumb interphalangeal joint. Her hobby was playing the erhu (a traditional two-stringed bowed Chinese instrument) and she wanted to improve her ability to hold the bow. To play the erhu, the tip of the thumb must touch the index finger to make a circle, and the other fingers must keep the bow horizontal and adjust the tension of the bow hair. We carried out thumb interphalangeal joint arthrodesis, little finger metacarpophalangeal joint arthrodesis, and transfer of the fourth dorsal interosseous muscle to the little finger. After 2 months of rehabilitation, the patient could hold the bow between the thumb and index fingers and adjust the string tension with the middle and ring fingers. Additionally, she could use chopsticks and pens more naturally. Discussion: Each patient with hand deformity resulting from burnt-out rheumatoid arthritis has a variety of demands for restoring hand function, depending on their personal needs. Individual treatment plans must be established through discussions among the patient, hand therapist, and surgeon based on the status of the hand and the patient’s needs.